Condom

Condom

A condom is a device most commonly used during sexual intercourse. It is put on a man's erect penis and physically blocks ejaculated semen from entering the body of a sexual partner. Condoms are used to prevent pregnancy and transmission of sexually transmitted diseases (STDs—such as gonorrhea, syphilis, and HIV). Because condoms are waterproof, elastic, and durable, they are also used in a variety of secondary applications. These range from creating waterproof microphones to protecting rifle barrels from clogging.

Most condoms are made from latex, but some are made from other materials. A female condom is also available. As a method of contraception, male condoms have the advantage of being inexpensive, easy to use, having few side-effects, and of offering protection against sexually transmitted diseases. With proper knowledge and application technique—and use at every act of intercourse—users of male condoms experience a 2% per-year pregnancy rate.

Condoms have been used for at least 400 years. Since the nineteenth century, they have been one of the most popular methods of contraception in the world. While widely accepted in modern times, condoms have generated some controversy. Improper disposal of condoms contributes to litter problems, and the Roman Catholic Church generally opposes condom use.

History

Before the 19th century

Whether condoms were used in ancient civilizations is debated by archaeologists and historians. In ancient Egypt, Greece, and Rome, pregnancy prevention was generally seen as a woman's responsibility, and the only well-documented contraception methods were female-controlled devices. In Asia prior to the fifteenth century, some use of glans condoms (devices covering only the head of the penis) is recorded. Condoms seem to have been used for birth control, and to have been known only by members of the upper classes. In China, glans condoms may have been made of oiled silk paper, or of lamb intestines. In Japan, they were made of tortoise shell or animal horn.

In 16th century Italy, Gabriele Falloppio wrote a treatise on syphilis. The earliest documented strain of syphilis, first appearing in a 1490s outbreak, caused severe symptoms and often death within a few months of contracting the disease. Fallopio's treatise is the earliest uncontested description of condom use: it describes linen sheaths soaked in a chemical solution and allowed to dry before use. The cloths he described were sized to cover the glans of the penis, and were held on with a ribbon. Fallopio claimed that an experimental trial of the linen sheath demonstrated protection against syphilis.

After this, the use of penis coverings to protect from disease is described in a wide variety of literature throughout Europe. The first indication that these devices were used for birth control, rather than disease prevention, is the 1605 theological publication De iustitia et iure (On justice and law) by Catholic theologian Leonardus Lessius, who condemned them as immoral. In 1666, the English Birth Rate Commission attributed a recent downward fertility rate to use of "condons", the first documented use of that word (or any similar spelling).

In addition to linen, condoms during the Renaissance were made out of intestines and bladder. In the late 15th century, Dutch traders introduced condoms made from "fine leather" to Japan. Unlike the horn condoms used previously, these leather condoms covered the entire penis.

From at least the 18th century, condom use was opposed in some legal, religious, and medical circles for essentially the same reasons that are given today: condoms reduce the likelihood of pregnancy, which some thought immoral or undesirable for the nation; they do not provide full protection against sexually transmitted infections, while belief in their protective powers was thought to encourage sexual promiscuity; and they are not used consistently due to inconvenience, expense, or loss of sensation.

Despite some opposition, the condom market grew rapidly. In the 18th century, condoms were available in a variety of qualities and sizes, made from either linen treated with chemicals, or "skin" (bladder or intestine softened by treatment with sulphur and lye). They were sold at pubs, barbershops, chemist shops, open-air markets, and at the theater throughout Europe and Russia. They later spread to America, although in every place there were generally used only by the middle and upper classes, due to both expense and lack of sexual education.

1800 through 1920s

The early nineteenth century saw contraceptives promoted to the poorer classes for the first time. Writers on contraception tended to prefer other methods of birth control. Feminists of this time period wanted birth control to be exclusively in the hands of women, and disapproved of male-controlled methods such as the condom. Other writers cited both the expense of condoms and their unreliability (they were often riddled with holes, and often fell off or broke), but they discussed condoms as a good option for some, and as the only contraceptive that also protected from disease.

Legal obstacles to manufacture and promotion of contraceptives were passed in many countries. Still, condoms were promoted by traveling lecturers and in newspaper advertisements, using euphemisms in places where such ads were illegal. Instructions on how to make condoms at home were distributed in the United States and Europe. Despite social and legal opposition, at the end of the nineteenth century the condom was the Western world's most popular birth control method.

Beginning in the second half of the nineteenth century, American rates of sexually transmitted diseases skyrocketed. Causes cited by historians include effects of the American Civil War, and the ignorance of prevention methods promoted by the Comstock laws. To fight the growing epidemic, sexual education classes were introduced to public schools for the first time, teaching about venereal diseases and how they were transmitted. They generally taught that abstinence was the only way to avoid sexually transmitted diseases. Condoms were not promoted for disease prevention; the medical community and moral watchdogs considered STDs to be punishment for sexual misbehavior. The stigma on victims of these diseases was so great that many hospitals refused to treat people who had syphilis.

The German military was the first to promote condom use among its soldiers, beginning in the later 1800s. Early twentieth century experiments by the American military concluded that providing condoms to soldiers significantly lowered rates of sexually transmitted diseases. During World War I, the United States and (at the beginning of the war only) Britain were the only countries with soldiers in Europe who did not provide condoms and promote their use.

In the decades after World War I, there continued to be social and legal obstacles to condom use in place in the U.S. and Europe. Founder of psychoanalysis Sigmund Freud opposed all methods of birth control on the grounds that their failure rates were too high. Freud was especially opposed to the condom because it cut down on sexual pleasure. Some feminists continued to oppose male-controlled contraceptives such as condoms. In 1920 the Church of England's Lambeth Conference condemned all "unnatural means of conception avoidance." London's Bishop Arthur Winnington-Ingram complained of the huge number of condoms discarded in alleyways and parks, especially after weekends and holidays.

However, European militaries continued to provide condoms to their members for disease protection, even in countries where they were illegal for the general population. Through the 1920s, catchy names and slick packaging became an increasingly important marketing technique for many consumer items, including condoms and cigarettes. Quality testing became more common, involving filling each condom with air followed by one of several methods intended to detect loss of pressure. Worldwide, condoms sales doubled in the 1920s.

Rubber and manufacturing advances

The rubber vulcanization process was patented by Charles Goodyear in 1844. The first rubber condom was produced in 1855. For many decades, rubber condoms were manufactured by wrapping strips of raw rubber around penis-shaped molds, then dipping the wrapped molds in a chemical solution to cure the rubber. In 1912, a German named Julius Fromm developed a new, improved manufacturing technique for condoms: dipping glass molds into a raw rubber solution. Called cement dipping, this method required adding gasoline or benzene to the rubber to make it liquid. Latex, rubber suspended in water, was invented in 1920. Latex condoms required less labor to produce than cement-dipped rubber condoms, which had to be smoothed by rubbing and trimming. Because it used water to suspend the rubber instead of gasolene and benzene, it eliminated the fire hazard previously associated with all condom manufacturers. Latex condoms also performed better for the consumer: they were stronger and thinner than rubber condoms, and had a shelf life of five years (compared to three months for rubber).

Until the twenties, all condoms were individually hand-dipped by semiskilled workers. Throughout the decade of the 1920s, advances in automation of condom assembly line were made. The first fully automated line was patented in 1930. Major condom manufacturers bought or leased conveyor systems, and small manufacturers were driven out of business. The skin condom, now significantly more expensive than the latex variety, became restricted to a niche high-end market.

1930 to present

In 1930 the Anglican Church's Lambeth Conference sanctioned the use of birth control by married couples. In 1931 the Federal Council of Churches in the U.S. issued a similar statement. The Roman Catholic Church responded by issuing the encyclical Casti Connubii affirming its opposition to all contraceptives, a stance it has never reversed.

In the 1930s, legal restrictions on condoms began to be relaxed. During this period, two of the few places where condoms became more restricted were Fascist Italy and Nazi Germany (limited sales as disease preventatives were still allowed). During the Depression, condom lines by Schmid gained in popularity: that company still used the cement-dipping method of manufacture. Unlike the latex variety, these condoms could be safely used with oil-based lubricants. And while less comfortable, older-style rubber condoms could be reused and so were more economical, a valued feature in hard times. More attention was brought to quality issues in the 1930s, and the U.S. Food and Drug Administration began to regulate the quality of condoms sold in the United States.

Throughout World War II, condoms were not only distributed to male U.S. military members, but also heavily promoted with films, posters, and lectures. European and Asian militaries on both sides of the conflict also provided condoms to their troops throughout the war, even Germany which outlawed all civilian use of condoms in 1941. In part because condoms were readily available, soldiers found a number of non-sexual uses for the devices, many of which continue to be utilized to this day.

After the war, condom sales continued to grow. From 1955-1965, 42% of Americans of reproductive age relied on condoms for birth control. In Britain from 1950-1960, 60% of married couples used condoms. The birth control pill became the world's most popular method of birth control in the years after its 1960 debut, but condoms remained a strong second. The U.S. Agency for International Development pushed condom use in developing countries to help solve the "world population crises": by 1970 hundreds of millions of condoms were being used each year in India alone.

In the 1960s and 1970s quality regulations tightened, and more legal barriers to condom use were removed. In Ireland, legal condom sales were allowed for the first time in 1978. Advertising, however was one area that continued to have legal restrictions. In the late 1950s, the American National Association of Broadcasters banned condom advertisements from national television: this policy remained in place until 1979.

After learning in the early 1980s that AIDS can be a sexually transmitted infection, the use of condoms was encouraged to prevent transmission of HIV. Despite opposition by some political, religious, and other figures, national condom promotion campaigns occurred U.S. and Europe. These campaigns increased condom use significantly.

Due to increased demand and greater social acceptance, condoms began to be sold in a wider variety of retail outlets, including in supermarkets and in discount department stores such as Wal-Mart. Condom sales increased every year until 1994, when media attention to the AIDS pandemic began to decline. The phenomenon of decreasing use of condoms as disease preventatives has been called prevention fatigue or condom fatigue. Observers have cited condom fatigue in both Europe and North America. As one response, manufacturers have changed the tone of their advertisements from scary to humorous. New developments continue to occur in the condom market, with the first polyurethane condom—branded Avanti and produced by the manufacturer of Durex—introduced in the 1990s. Worldwide condom use is expected to continue to grow: one study predicted that developing nations would need 18.6 billion condoms in 2015. For the boom of the condom industry, it appears there is no end in sight.

Etymology and other terms

Etymological theories for the word "condom" abound. By the early 1700s, the invention and naming of the condom was attributed to an associate of England's King Charles II, and this explanation persisted for several centuries. However, the "Dr. Condom" or "Earl of Condom" described in these stories never existed, and condoms had been used for over one hundred years before King Charles II ascended to the throne.

A variety of Latin etymologies have been proposed, including condon (receptacle), condamina (house), and cumdum (scabbard or case). It has also been speculated to be from the Italian word guantone, derived from guanto, meaning glove. William E. Kruck wrote an article in 1981 concluding that, "As for the word 'condom', I need state only that its origin remains completely unknown, and there ends this search for an etymology." Modern dictionaries may also list the etymology as "unknown".

Other terms are also commonly used to describe condoms. In North America condoms are also commonly known as prophylactics, or rubbers. In Britain they may be called French letters. Additionally, condoms may be referred to using the manufacturer's name.

Varieties

Most condoms have a reservoir tip or teat end, making it easier to accommodate the man's ejaculate. Condoms come in different sizes, from oversized to snug and they also come in a variety of surfaces intended to stimulate the user's partner. Condoms are usually supplied with a lubricant coating to facilitate penetration, while flavoured condoms are principally used for oral sex. As mentioned above, most condoms are made of latex, but polyurethane and lambskin condoms are also widely available.

Materials

Natural latex

Latex has outstanding elastic properties: Its tensile strength exceeds 30 MPa, and latex condoms may be stretched in excess of 800% before breaking. In 1990 the ISO set standards for condom production (ISO 4074, Natural latex rubber condoms), and the EU followed suit with its CEN standard (Directive 93/42/EEC concerning medical devices). Every latex condom is tested for holes with an electrical current. If the condom passes, it is rolled and packaged. In addition, a portion of each batch of condoms is subject to water leak and air burst testing.
Latex condoms used with oil-based lubricants (e.g. vaseline) are likely to break or slip off due to loss of elasticity caused by the oils.

Synthetic

Polyurethane condoms tend to be the same width and thickness as latex condoms, with most polyurethane condoms between 0.04 mm and 0.07 mm thick. Polyurethane is also the material of many female condoms.

Polyurethane can be considered better than latex in several ways: it conducts heat better than latex, is not as sensitive to temperature and ultraviolet light (and so has less rigid storage requirements and a longer shelf life), can be used with oil-based lubricants, is less allergenic than latex, and does not have an odor. Polyurethane condoms have gained FDA approval for sale in the United States as an effective method of contraception and HIV prevention, and under laboratory conditions have been shown to be just as effective as latex for these purposes.

However, polyurethane condoms are less elastic than latex ones, and may be more likely to slip or break than latex, and are more expensive.

Polyisoprene is a synthetic version of natural rubber latex. While significantly more expensive, it has the advantages of latex (such as being softer and more elastic than polyurethane condoms) without the protein which is responsible for latex allergies.

Lambskin

Condoms made from one of the oldest condom materials, labeled "lambskin" (made from lambintestines) are still available. They have a greater ability to transmit body warmth and tactile sensation, when compared to synthetic condoms, and are less allergenic than latex. However, there is an increased risk of transmitting STDs compared to latex because of pores in the material, which are thought to be large enough to allow infectious agents to pass through, albeit blocking the passage of sperm. Lambskin condoms are also significantly more expensive than other types.

Spermicidal

Some latex condoms are lubricated at the manufacturer with a small amount of a nonoxynol-9, a spermicidal chemical. According to Consumer Reports, spermicidally lubricated condoms have no additional benefit in preventing pregnancy, have a shorter shelf life, and may cause urinary-tract infections in women. In contrast, application of separately packaged spermicide is believed to increase the contraceptive efficacy of condoms.

Nonoxynol-9 was once believed to offer additional protection against STDs (including HIV) but recent studies have shown that, with frequent use, nonoxynol-9 may increase the risk of HIV transmission. The World Health Organization says that spermicidally lubricated condoms should no longer be promoted. However, they recommend using a nonoxynol-9 lubricated condom over no condom at all. As of 2005, nine condom manufacturers have stopped manufacturing condoms with nonoxynol-9, Planned Parenthood has discontinued the distribution of condoms so lubricated, and the Food and Drug Administration has proposed a warning regarding this issue.

Female

Female condoms (also known as femidoms) are also available. They are larger and wider than male condoms but equivalent in length. They have a flexible ring-shaped opening, and are designed to be inserted into the vagina. They also contain an inner ring which aids insertion and helps keep the condom from sliding out of the vagina during coitus. One line of female condoms is made from polyurethane or nitrilepolymer. A competing manufacturer makes a line of female condoms out of latex. The latex female condom has been available for several years in Africa, Asia, and South America, although as of 2008 it was not available in the United States.

Other

A collection condom is used to collect semen for fertility treatments or sperm analysis. These condoms are designed to maximize sperm life.

An anti-rape condom is worn by the female. It is designed to cause pain to the attacker, hopefully allowing the victim a chance to escape.

Some condom-like devices are intended for entertainment only, such novelty condoms may not provide protection against pregnancy and STDs. One kind of these is edible condoms.

Effectiveness

In preventing pregnancy

The effectiveness of condoms, as of most forms of contraception, can be assessed two ways. Perfect use or method effectiveness rates only include people who use condoms properly and consistently. Actual use, or typical use effectiveness rates are of all condom users, including those who use condoms improperly, inconsistently, or both. Rates are generally presented for the first year of use. Most commonly the Pearl Index is used to calculate effectiveness rates, but some studies use decrement tables.

The typical use pregnancy rate among condom users varies depending on the population being studied, ranging from 10–18% per year. The perfect use pregnancy rate of condoms is 2% per year. Condoms may be combined with other forms of contraception (such as spermicide) for greater protection.

Several factors account for typical use effectiveness being lower than perfect use effectiveness:

mistakes on the part of those providing instructions on how to use the method

mistakes on the part of the user

conscious user non-compliance with instructions.

For instance, someone might be given incorrect information on what lubricants are safe to use with condoms, mistakenly put the condom on improperly, or simply not bother to use a condom.

In preventing STDs

Condoms are widely recommended for the prevention of sexually transmitted diseases (STDs). They have been shown to be effective in reducing infection rates in both men and women. While not perfect, the condom is effective at reducing the transmission of HIV, genital herpes, genital warts, syphilis, chlamydia, gonorrhea, and other diseases.

According to a 2000 report by the National Institutes of Health, correct and consistent use of latex condoms reduces the risk of HIV/AIDS transmission by approximately 85% relative to risk when unprotected, putting the seroconversion rate (infection rate) at 0.9 per 100 person-years with condom, down from 6.7 per 100 person-years. The same review also found condom use significantly reduces the risk of gonorrhea for men.

A 2006 study reports that proper condom use decreases the risk of transmission for human papillomavirus by approximately 70%. Another study in the same year found consistent condom use was effective at reducing transmission of herpes simplex virus-2 also known as genital herpes, in both men and women.

Although a condom is effective in limiting exposure, some disease transmission may occur even with a condom. Infectious areas of the genitals, especially when symptoms are present, may not be covered by a condom, and as a result, some diseases can be transmitted by direct contact. The primary effectiveness issue with using condoms to prevent STDs, however, is inconsistent use.

Condoms may also be useful in treating potentially precancerous cervical changes. Exposure to human papillomavirus, even in individuals already infected with the virus, appears to increase the risk of precancerous changes. The use of condoms helps promote regression of these changes. In addition, researchers in the UK suggest that a hormone in semen can aggravate existing cervical cancer, condom use during sex can prevent exposure to the hormone.

Causes of failure

Condoms may slip off the penis after ejaculation, break due to improper application or physical damage (such as tears caused when opening the package), or break or slip due to latex degradation (typically from usage past the expiration date, improper storage, or exposure to oils). The rate of breakage is between 0.4% and 2.3%, while the rate of slippage is between 0.6% and 1.3%. Even if no breakage or slippage is observed, 1–2% of women will test positive for semen residue after intercourse with a condom.
"Double bagging," using two condoms at once, also increases the risk of condom failure.

Different modes of condom failure result in different levels of semen exposure. If a failure occurs during application, the damaged condom may be disposed of and a new condom applied before intercourse begins - such failures generally pose no risk to the user. One study found that semen exposure from a broken condom was about half that of unprotected intercourse; semen exposure from a slipped condom was about one-fifth that of unprotected intercourse.

Standard condoms will fit almost any penis, although many condom manufacturers offer "snug" or "magnum" sizes. Some studies have associated larger penises and smaller condoms with increased breakage and decreased slippage rates (and vice versa), but other studies have been inconclusive.

Experienced condom users are significantly less likely to have a condom slip or break compared to first-time users, although users who experience one slippage or breakage are more likely to suffer a second such failure. An article in Population Reports suggests that education on condom use reduces behaviors that increase the risk of breakage and slippage. A Family Health International publication also offers the view that education can reduce the risk of breakage and slippage, but emphasizes that more research needs to be done to determine all of the causes of breakage and slippage.

Among people who intend condoms to be their form of birth control, pregnancy may occur when the user has sex without a condom. The person may have run out of condoms, or be traveling and not have a condom with them, or simply dislike the feel of condoms and decide to "take a chance." This type of behavior is the primary cause of typical use failure (as opposed to method or perfect use failure).

Another possible cause of condom failure is sabotage. One motive is to have a child against a partner's wishes or consent. Some commercial sex workers report clients sabotaging condoms in retaliation for being coerced into condom use. Placing pinholes in the tip of the condom is believed to significantly impact their effectiveness.

Prevalence

The prevalence of condom use varies greatly between countries. Most surveys of contraceptive use are among married women, or women in informal unions. Japan has the highest rate of condom usage in the world: in that country, condoms account for almost 80% of contraceptive use by married women. On average, in developed countries, condoms are the most popular method of birth control: 28% of married contraceptive users rely on condoms. In the average less-developed country, condoms are less common: only 6-8% of married contraceptive users choose condoms.

Condom use for disease prevention also varies. Among gay men in the United States, one survey found that 35% had used two condoms at the same time, a practice called "double bagging". (While intended to provide extra protection, double bagging actually increases the risk of condom failure.)

Use

Male condoms are usually packaged inside a foil wrapper, in a rolled-up form, and are designed to be applied to the tip of the penis and then unrolled over the erect penis. It is important that about some space be left in the tip of the condom so that semen has a place to collect; otherwise it may be forced out of the base of the device. After use, it is recommended the condom be wrapped in tissue or tied in a knot, then disposed of in a trash receptacle.

Some couples find that putting on a condom interrupts sex, although others incorporate condom application as part of their foreplay. Some men and women find the physical barrier of a condom dulls sensation. Advantages of dulled sensation can include prolonged erection and delayed ejaculation; disadvantages might include a loss of some sexual excitement.

Role in sex education

Condoms are often used in sexual education programs, because they have the capability to reduce the chances of pregnancy and the spread of some sexually transmitted diseases when used correctly. A recent American Psychological Association (APA) press release supported the inclusion of information about condoms in sex education, saying "comprehensive sexuality education programs... discuss the appropriate use of condoms", and "promote condom use for those who are sexually active."

In the United States, teaching about condoms in public schools is opposed by some religious organizations. Planned Parenthood, which advocates family planning and sexual education, argues that no studies have shown abstinence-only programs to result in delayed intercourse, and cites surveys showing that 75% of American parents want their children to receive comprehensive sexuality education including condom use.

Infertility treatment

Common procedures in infertility treatment such as semen analysis and intrauterine insemination (IUI) require collection of semen samples. These are most commonly obtained through masturbation, but an alternative to masturbation is use of a special collection condom to collect semen during sexual intercourse.

Collection condoms are made from silicone or polyurethane, as latex is somewhat harmful to sperm. Many men prefer collection condoms to masturbation, and some religions prohibit masturbation entirely. Also, compared with samples obtained from masturbation, semen samples from collection condoms have higher total sperm counts, sperm motility, and percentage of sperm with normal morphology. For this reason, they are believed to give more accurate results when used for semen analysis, and to improve the chances of pregnancy when used in procedures such as intracervial or intrauterine insemination. Adherents of religions that prohibit contraception, such as Catholicism, may use collection condoms with holes pricked in them.

Condom therapy is sometimes prescribed to infertile couples when the female has high levels of antisperm antibodies. The theory is that preventing exposure to her partner's semen will lower her level of antisperm antibodies, and thus increase her chances of pregnancy when condom therapy is discontinued. However, condom therapy has not been shown to increase subsequent pregnancy rates.

Other uses

Condoms excel as multipurpose containers because they are waterproof, elastic, durable, and will not arouse suspicion if found. Ongoing military utilization begun during World War II includes:

Tying a non-lubricated condom over the muzzle of the rifle barrel in order to prevent barrel fouling by keeping out detritus.

The OSS used condoms for a plethora of applications, from storing corrosive fuel additives and wire garrotes (with the T-handles removed) to holding the acid component of a self-destructing film canister, to finding use in improvised explosives.

Navy SEALs have used doubled condoms, sealed with neoprene cement, to protect non-electric firing assemblies for underwater demolitions—leading to the term "Dual Waterproof Firing Assemblies.

Other uses of condoms include:

Condoms can be used to hold water in emergency survival situations.

Condoms have also been used in many cases to smugglecocaine and other drugs across borders and into prisons by filling the condom with drugs, tying it in a knot and then either swallowing it or inserting it into the rectum. These methods are very dangerous; if the condom breaks, the drugs inside can cause an overdose.

In Sovietgulags, condoms were used to smuggle alcohol into the camps by prisoners who worked outside during daylight. While outside, the prisoner would ingest an empty condom attached to a thin piece of rubber tubing, the end of which was wedged between his teeth. The smuggler would then use a syringe to fill the tubing and condom with up to three litres of raw alcohol, which the prisoner would then smuggle back into the camp. When back in the barracks, the other prisoners would suspend him upside down until all the spirit had been drained out. Aleksandr Solzhenitsyn records that the three litres of raw fluid would be diluted to make seven litres of crude vodka, and that although such prisoners risked an extremely painful and unpleasant death if the condom burst inside them, the rewards granted them by other prisoners encouraged them to run the risk.

In his book entitled Last Chance to See, Douglas Adams reported having used a condom to protect a microphone he used to make an underwater recording. According to one of his travelling companions, this is standard BBC practice when a waterproof microphone is needed but cannot be procured.

Condoms are used by engineers to keep soil samples dry during soil tests.

Condoms are used in the field by engineers to initially protect sensoring equipment embedded in the steel or aluminium nose-cones of CPT (Cone Penetration Test) probes when entering the surface to conduct soil resistance tests to determine the bearing strength of soil.

Condoms are used as a one way valve by paramedics when performing a chest decompression in the field. The decompression needle is inserted through the condom, and inserted into the chest. The condom folds over the hub allowing air to exit the chest, but preventing it from entering.

Debate and criticism

Disposal and environmental impact

Experts recommend condoms be disposed of in a trash receptacle. Flushing down the toilet may clog plumbing or cause other problems.

While biodegradable, latex condoms damage the environment when disposed of improperly. According to the Ocean Conservancy, condoms, along with certain other types of trash, cover the coral reefs and smother sea grass and other bottom dwellers. The United States Environmental Protection Agency also has expressed concerns that many animals might mistake the litter for food.

Condoms made of polyurethane, a plastic material, do not break down at all. The plastic and foil wrappers condoms are packaged in are also not biodegradable. However, the benefits condoms offer are widely considered to offset their small landfill mass. Frequent condom or wrapper disposal in public areas such as a parks have been seen as a persistent litter problem.

Position of the Roman Catholic Church

The Roman Catholic Church directly condemns any artificial birth control or sexual acts, aside from intercourse between married heterosexual partners. However, the use of condoms to combat STDs is not specifically addressed by Catholic doctrine, and is currently a topic of debate among theologians and high-ranking Catholic authorities. A few, such as Belgian Cardinal Godfried Danneels, believe the Catholic Church should actively support condoms used to prevent disease, especially serious diseases such as AIDS. However, to date statements from the Vatican have argued that condom-promotion programs encourage promiscuity, thereby actually increasing STD transmission. Papal study of the issue is ongoing, and in 2006 a study on the use of condoms to combat AIDS was prepared for review by Pope Benedict XVI.

The Roman Catholic Church is the largest organized body of any world religion. This church has hundreds of programs dedicated to fighting the AIDS epidemic in Africa, but its opposition to condom use in these programs has been highly controversial.

Health issues

Dry dusting powders are applied to latex condoms before packaging to prevent the condom from sticking to itself when rolled up. Previously, talc was used by most manufacturers, however cornstarch is currently the most popular dusting powder. Talc is known to be toxic if it enters the abdominal cavity (i.e. via the vagina). Cornstarch is generally believed to be safe, however some researchers have raised concerns over its use.

Nitrosamines, which are potentially carcinogenic in humans, are believed to be present in a substance used to improve elasticity in latex condoms. A 2001 review stated that humans regularly receive 1,000 to 10,000 times greater nitrosamine exposure from food and tobacco than from condom use and concluded that the risk of cancer from condom use is very low. However, a 2004 study in Germany detected nitrosamines in 29 out of 32 condom brands tested, and concluded that exposure from condoms might exceed the exposure from food by 1.5- to 3-fold.

Major manufacturers

One analyst described the size of the condom market as something that "boggles the mind". Numerous small manufacturers, nonprofit groups, and government-run manufacturing plants exist around the world. Within the condom market, there are several major contributors, among them both for-profit businesses and philanthropic organizations. Most large manufacturers have ties to the business that reach back to the end of the 19th century.

Julius Schmid, Inc. was founded in 1882 and began the Shieks and Ramses brands of condoms. The London Rubber Company began manufacturing latex condoms in 1932, under the Durex brand. Both companies are now part of Seton Scholl Limited.

Youngs Rubber Company, founded by Merle Youngs in late nineteenth century America, introduced the Trojan line of condoms now owned by Church and Dwight.

Dunlop Rubber began manufacturing condoms in Australia in the 1890s. In 1905, Dunlop sold its condom-making equipment to one of its employees, Eric Ansell, who founded Ansell Rubber. In 1969, Ansell was sold back to Dunlop. In 1987, English business magnate Richard Branson contracted with Ansell to help in a campaign against HIV and AIDS. Ansell agreed to manufacture the Mates brand of condom, to be sold at little or no profit in order to encourage condom use. Branson soon sold the Mates brand to Ansell, with royalty payments made annually to the charity Virgin Unite. In addition to its Mates brand, Ansell currently manufactures Lifestyles for the U.S. market.

In 1934 the Kokusia Rubber Company was founded in Japan. It is now known as the Okamoto Rubber Manufacturing Company.

In 1970 Tim Black and Philip Harvey founded Population Planning Associates (now known as Adam & Eve). Population Planning Associates was a mail-order business that marketed condoms to American college students. Black and Harvey used the profits from their company to start a non-profit organization Population Services International, and Harvey later also founded another nonprofit company, DKT International that annually sells millions of condoms at discounted rates in developing countries around the world.

Public Policy

In the last quarter of 20th century, Third World governments, such as India, began procuring condoms on large scale to facilitate national population control schemes by reselling them at subsidised prices.

Research

The Invisible Condom, developed at Université Laval in Québec, Canada, is a gel that hardens upon increased temperature after insertion into the vagina or rectum. In the lab, it has been shown to effectively block HIV and herpes simplex virus. The barrier breaks down and liquefies after several hours. As of 2005, the invisible condom is in the clinical trial phase, and has not yet been approved for use.

Also developed in 2005 is a condom treated with an erectogenic compound. The drug-treated condom is intended to help the wearer maintain his erection, which should also help reduce slippage. If approved, the condom would be marketed under the Durex brand. As of 2007, it was still in clinical trials.

As reported on Swiss television news Schweizer Fernsehen on November 29, 2006, the German scientist Jan Vinzenz Krause of the Institut für Kondom-Beratung ("Institute for Condom Consultation") in Germany recently developed a spray-on condom and is test-marketing it. Krause says that one of the advantages to his spray-on condom, which is reported to dry in about 5 seconds, is that it is perfectly formed to each penis.